Population-based interventions for the prevention of fall-related injuries in older people (Review)

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Background Fall-related injuries are a significant cause of morbidity and mortality in older populations. Summary information about countermeasures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll out of these countermeasures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regard to fall-related injuries among older people. Objectives To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people. Search strategy We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, National Research Register, AgeInfo, PsycInfo and Web of Knowledge. We also searched the internet, carried out handsearches of selected journals and checked the reference lists of relevant papers to identify any further studies. The latest search was conducted in May 2007. Selection criteria Studies were independently screened for inclusion by two review authors. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention. Data collection and analysis Data were independently extracted by two review authors. Meta-analysis was not appropriate due to the heterogeneity of the included studies. Main results Out of 35 identified studies, six met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in each of the included studies, with the relative reduction in fall-related injuries ranging from 6% to 33%. Authors' conclusions Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.